Provider Demographics
NPI:1033648811
Name:STAKOLOSA, MIKAYLA SUE (LLMSW)
Entity type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:SUE
Last Name:STAKOLOSA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:MIKAYLA
Other - Middle Name:SUE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:5024 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9412
Practice Address - Country:US
Practice Address - Phone:989-790-3130
Practice Address - Fax:989-790-3139
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical